tbuckley/cabot-search huggingface dataset:
Abstract 9539: Risk of Earlier Atherosclerotic Cardiovascular Disease in Women With Low Bone Mineral Density
Authors: Jiesuck Park, Kyoung Min Kim, Yeonyee E Yoon, In-chang Hwang, Goo-Yeong Cho
Journal: Circulation (2022)

Background: The potential association between lower bone mineral density (BMD) and atherosclerotic cardiovascular disease (ASCVD) has been suggested in women. We investigated whether the association between low BMD and ASCVD differs according to the age of ASCVD occurrence. Methods: We retrospectively analyzed 7,932 women aged 50-65 years who underwent dual-energy X-ray absorptiometry to measure total hip BMD. The primary outcome of interest was ASCVD, defined as a composite of ASCVD death, myocardial infarction, and ischemic stroke. Participants were classified into no event (n=7,803), early ASCVD (occured before 70 years of age) (n=97), and late ASCVD (occured at or after 70 years of age) (n=32) groups. The association of low BMD with early and late ASCVD was estimated using multivariate Cox hazard modeling after adjustment for clinical risk factors (age, body mass index, hypertension, diabetes, hyperlipidemia, current smoking, and previous fracture). Results: The median age increased across no event, early ASCVD, and late ASCVD groups (58, 60, and 63 years, respectively). However, the estimated BMD T-score at the age of 65 years was lowest in the early ASCVD group (median -0.9, -1.1, and -0.5, respectively). Lower BMD was an independent predictor for early ASCVD (adjusted hazard ratio [HR]: 1.34 per 1-SD decrease in T-score, 95% confidence interval [CI] 1.08-1.67), but not late ASCVD (adjusted HR: 0.88, 95% CI 0.60-1.30) (Figure). The inverse trend between early ASCVD risk and BMD T-score was consistent regardless of the number of accompanied clinical risk factors. Conclusions: Low BMD is an independent predictor for earlier ASCVD occurrence in women. BMD evaluation can provide prognostic benefit for risk stratification for earlier ASCVD occurrence.
Abstract 9691: Incidence of Atrial Fibrillation in Patients Hospitalized for COVID Compared to Non-COVID Pneumonia/ARDS
Authors: Hannah Bernstein, Brian Paciotti, Uma N Srivatsa
Journal: Circulation (2022)

Introduction: Though atrial fibrillation (AF) has been reported with COVID, it is unclear if it is related to myocarditis or lung injury. The aim of this study was to compare incident AF in pneumonia/ARDS with and without COVID. Methods: In this retrospective multicenter cohort study from 17 hospitals (3/2020 to 12/2021) utilizing the University of California COVID Research Data Set (CORDS), we included patients &gt;18 years with primary diagnosis of pneumonia or ARDS during hospitalization by ICD-10. We excluded those with prior AF. Subjects were determined to have COVID based on positive PCR test within 10 days prior or during inpatient admission and compared to a control group with negative PCR test. Clinical data was extracted from electronic medical records. The cohorts were compared using χ2 test for categorical variables and Wilcoxon rank tests for continuous variables. Multivariable logistic regression models were used to investigate the association between COVID and development of new atrial fibrillation. Results: Of the 39,415 subjects, 12.2% had COVID. The COVID+ cohort was younger, had more males, and more co-morbidities. They required more mechanical ventilation, but less ICU care and hemodynamic support (Table 1). Incident AF occurred in 523 (10.85%) of COVID vs 4,899 (14.16%) in the non-COVID group (OR 0.74, p &lt; 0.001), which remained significant after adjustment of demographics and co-morbidities (p &lt; 0.001). AF was associated with higher mortality (26.2% vs. 10.21%, p &lt;0.001) and longer hospitalization (22.5 vs. 15.1 days, p &lt;0.001) in COVID group compared to the controls (Table 2). Conclusions: Incident AF is less in COVID compared to non-COVID pneumonia/ARDS despite requiring more mechanical ventilation, however had higher mortality and prolonged hospitalization.
Abstract 9552: Optimal Sensing Vector for Maximal Pwave Amplitude, Implications for Insertable Cardiac Monitor (ICM) Implantation
Authors: Bradley M Pitman, Dennis H Lau
Journal: Circulation (2022)

Introduction: Pwave visibility on electrograms (EGMs) obtained by Insertable Cardiac Monitor (ICM) can enhance the diagnostic accuracy of atrial arrhythmias. Objective: To assess the optimal sensing vector for maximal Pwave amplitude obtained on sinus rhythm strips from the precordial region of patients undergoing cardiac investigation. Methods: 150 participants each had 12 separate tracings of single-lead surface EKG acquired using Northeast Holter (DR200/HE) placed to mimic ICM recordings. 3M electrodes were positioned at different vector length (75mm &amp; 45mm) for each of three angles (vertical, oblique, horizontal) repeated in two postures (upright &amp; supine). Impedance-based body fat percentage (BF%) was measured. Fifty patients also received ICM implant in 1:1 recruitment (Medtronic LINQ:Biotronik Biomonitor IIIm) with device EGM attained. All EKG and EGM were uploaded into DigitizeIt software for offline analysis by blinded technicians who measured calibrated Pwave amplitude. The minimum amplitude for readily visible Pwave on ICM has previously been reported as .015mV, and this threshold was used to define acceptable Pwave amplitude. Results: 150 participants [55.5% male, median age 59years (IQR 35 - 73)] each had 12 EKG strips obtained (total 1,800). Median Pwave was 45% larger for 75 vs. 45mm (.042 vs. .029mV, p&lt;.001). Good correlation was seen for EKG and EGM, with Pwave ICC .74 (95%CI .58 - .84). In total, 79% (n=1,415) of EKG had sufficient Pwave visibility (≥.015mV), with a greater proportion seen for 75 vs. 45mm vector (84% vs 73%, p&lt;.001). Overall, Pwave amplitude was lower for higher BF% patients. Among the top third BF% (figure), Pwaves were twice [OR 2.03 (95%CI 1.04 - 3.95)] as likely to be of visible amplitude for 75mm vector (oblique angle) compared to the best 45mm vector (vertical). Conclusion: Longer sensing vector provides superior Pwave amplitude, particularly for high BF%, which is important when factoring ICM device selection for patients.
Abstract 9446: Psychosocial Readiness Assessment for Heart Transplant Candidates
Authors: Audrey C Kleet, MaryJane A Farr, Carmen Alvarez
Journal: Circulation (2022)

Background: Psychosocial evaluation for heart transplant suitability has long been required by the Centers for Medicare and Medicaid Services as a condition of participation for transplant programs in the US. There is no regulation regarding follow-up psychosocial care and re-assessment of patients waitlisted for transplantation. Heart transplant candidates require a thorough initial evaluation of multiple psychosocial factors and are at risk of negative outcomes with mental health problems and/or unstable socioeconomic resources. Purpose: A descriptive surveillance quality improvement project was developed to evaluate the effects of psychosocial readiness assessments for waitlisted United Network for Organ Sharing status 3, 4, and 5 adult heart transplant candidates in the outpatient setting, addressing basic socioeconomic needs and mental wellness in preparation for transplantation. Methods: To determine acceptability, rescheduled readiness visits and no-show rates were measured. A post-implementation period Qualtrics RM survey was administered to measure team member perceptions of feasibility. Socioeconomic elements of caregiver support, housing, transportation, and insurance status were assessed by simple using “yes/no” questions. The General Anxiety Disorder-7 questionnaire and the Patient Health Questionnaire-8 were used to assess anxiety and depression, respectively. Results: Fifty-seven patients were assessed during the 12-week period. The primary aim of feasibility was achieved with 93% of visits performed with freedom from rescheduling or patient no-show. Seventy five percent of team members reported the readiness assessments were achievable. More than twenty-four percent (24.56%) of patients required follow-up from a transplant Social Worker with 94.74% of those referrals due solely to elevated mental health questionnaire scores. Conclusion: Addressing non-medical and mental health needs in waitlisted heart transplant patients allows transplant programs to maintain candidates with necessary resources. The readiness assessments are feasible in practice and may serve to reduce untoward outcomes in the post-transplant phase by providing targeted care prior to the time of transplant.
Abstract 9536: The Influence of Social Determinants of Health and Race on Pediatric Heart Transplant Outcomes
Authors: Shahnawaz Amdani, Alfred Asante-Korang, James K Kirklin, Hong Zhao, Ryan Cantor, Jesse Schold, Estela Azeka
Journal: Circulation (2022)

Introduction: While traditional registry-based analyses have outlined that Black children have worse post-heart transplant (HT) outcomes, it is not entirely clear if such differences persist after accounting for social determinants of health (SDOH). Hypothesis: After accounting for SDOH, Black children from distressed communities will continue to have worse post-HT outcomes compared to White children. Methods: All children in the Pediatric Heart Transplant Society (PHTS) database that underwent HT in the U.S. from January 2010 - December 2020 were included. Recipient zip codes from PHTS and the Scientific Registry of Transplant Recipients databases were used to create a pediatric specific community risk score for each transplanted recipient. Lower risk communities (quartiles 1 and 2) were labelled prosperous and the higher risk (quartiles 3 and 4) as distressed communities. The effects of community risk and self-identified race on post-HT rejection, cardiac allograft vasculopathy (CAV) and graft loss were evaluated unadjusted and after adjusting for donor and recipient risk factors. Results: Of 3680 children transplanted, 1911 (51.9%) lived in prosperous and 1769 (48.1%) in distressed communities. Unadjusted analysis revealed that Black children from distressed communities had higher rejection (p=0.0013), CAV (p=0.0011) and graft loss (p&lt;0.0001) (Figure) . In multivariable adjusted analysis, Black children from distressed communities experienced increased rejection (HR 1.33, 95%CI 1.03-1.71), CAV (HR 2.06, 95%CI 1.21-3.51) and graft loss (HR 1.66, 95%CI 1.12-2.46), while white children did not experience increased rejection (HR 0.99, 95%CI 0.86-1.14), CAV (HR 0.95, 95%CI 0.69-1.32) or graft loss (HR 1.17, 95%CI 0.92-1.48). Conclusions: This study found that SDOH independently affects post-HT outcomes for Black, but not White children. More studies will be necessary to identify the root causes to be able to address these racial disparities.
Abstract 9574: Distribution of Anti-Factor Xa Activity Value, Prothrombin Time, and Activated Partial Thromboplastin Time in Patients Treated With Factor Xa Inhibitors
Authors: Ryohei Ono, Kenichi Fukushima, Hidehisa Takahashi, Yasuhiko Hori, Yoshio Kobayashi
Journal: Circulation (2022)

Introduction: The distribution of anti-factor Xa activity (AXA) values, prothrombin time (PT), and activated partial thromboplastin time (APTT) in patients administered each factor Xa (FXa) inhibitors (apixaban, edoxaban, and rivaroxaban) has not fully been assessed. Purpose: To clarify the distribution of AXA, PT, and APTT in patients taking FXa inhibitors. Methods: Trough and peak AXA values, PT, and APTT were measured in 85 patients taking apixaban, 105 patients taking edoxaban, and 27 patients taking rivaroxaban. The patients were further divided into three groups based on the dosage. Results: At trough time of apixaban, the AXA values in patients administered 20 mg were significantly higher than those administered 5 mg or 10 mg (P &lt; 0.001). PT in patients administered 20 mg were significantly higher than those administered 5 mg or 10 mg (P = 0.006). At peak time, the AXA values in patients administered 20 mg were significantly higher than those administered 5 mg or 10 mg (P &lt; 0.001). PT in patients administered 20 mg was significantly higher than those administered 5 mg or 10 mg (P &lt; 0.001). APTT in patients administered 20 mg was significantly higher than those administered 5 mg or 10 mg (P &lt; 0.001). At peak time of edoxaban, the AXA values in patients administered 60 mg were significantly higher than those administered 15 mg or 30 mg (P &lt; 0.001). PT in patients administered 60 mg were significantly higher than those administered 15 mg or 30 mg (P = 0.006). APTT in patients administered 60 mg was significantly higher than those administered 30 mg (P = 0.003). At trough time of rivaroxaban, the AXA values in patients administered 30 mg were significantly higher than those administered 10 mg or 15 mg (P = 0.001). At peak time, AXA values in patients administered 30 mg were significantly higher than those administered 15 mg (P = 0.028). Conclusion: This study determined the distribution of AXA, PT, and APTT in patients administered apixaban, edoxaban, and rivaroxaban.
Abstract 9525: Changes in Managing Post-Stroke Challenges After Receiving a Self-Management Programme: A Qualitative Study
Authors: Suzanne H Lo, Janita P Chau, Issac Hok Lai Iu
Journal: Circulation (2022)

Introduction: Supporting self-management is essential to improving health outcomes after stroke. More evidence on the stroke survivors’ experiences and perceived usefulness of the self-management interventions are needed to provide better support. Purpose: This study was aimed to explore stroke survivors’ experiences of attending an 8-week programme which consisted of four home visits and five follow-up phone calls and delivered by a collaborative team of nurses and trained lay volunteers. Methods: A qualitative study was conducted with a convenience sample of the survivors who had received the programme. After completing the programme, the survivors were interviewed individually by phone using a semi-structured interview guide about their changes in perceiving and responding to post-stroke physical and psychosocial challenges. Suggestions to improve their experience of participation were collected. Interview data were transcribed verbatim and analysed thematically. Results: Thirty stroke survivors (mean age=60 years, SD=11.74) were interviewed. Most of them were male (60%), married (63.3%) and had a first-ever ischaemic stroke (50%). The mean duration of onset after stroke was 5.63 years (SD=3.12). About 63% of them walked unaided or with a stick. Four (13.3%) had mild dysphasia. Four themes were derived: developed short-term goals with lifestyle-integrated action plans; resumed social activities or work; increased satisfaction with life and sense of being cared for; more effective communication and relief of negative emotions; increased adoption of new and creative strategies to improve limb functions. Suggestions for improving the programme included longer duration, more home visits, earlier support upon discharge from the hospital, meetings with other survivors for mutual support while working towards the goals, and more structured follow-up phone calls. Conclusions: The self-management programme was found helpful in improving the survivors’ confidence and performance of self-management behaviours. Making the programme available upon discharge, and extending its duration with more home visits, group sessions and structured phone calls would build stronger self-management capabilities in survivors.
Abstract 9537: Preliminary Analysis of the Impact of IV Iron Repletion in Patients With Iron Deficiency Anemia and Chronic Thromboembolic Pulmonary Hypertension Undergoing Pulmonary Thromboendarterectomy
Authors: Madeline Lee, Allan Lin, Rylie Pietrowicz, Rohit Maruthi, Anjali Vaidya, Estefania Oliveros, Paul R Forfia
Journal: Circulation (2022)

Introduction: Iron deficiency anemia (IDA) is associated with worse functional class, shorter 6-minute walk distance (6MWD), and higher mortality in heart failure. The associations of IDA with chronic thromboembolic pulmonary hypertension (CTEPH) have not been established. Methods: Retrospective chart review of 95 patients with CTEPH who underwent pulmonary thromboendarterectomy (PTE) and had iron studies. We determined the prevalence of IDA and the impact of IV iron repletion in the perioperative period. Results: Of the 95 patients, the mean age was 56 years, 55% were female, 52% were White, and 28% were Black. Thirteen (13.6%) had IDA and received IV iron perioperatively when admitted for PTE. Those who had IDA were younger (50.3 vs 57.7 years, p=0.09) and female (69.2%). Of the females, 3 (33.3%) had uterine fibroids. Baseline hemoglobin was lower in the group requiring IV iron (10.5 vs 13.1 g/dL, p=0.0004). The patients received 1-5 days of IV iron. Cardiac index (CI) pre-PTE was not different between IDA versus non-IDA groups (2.4 vs 2.2 L/min, p=0.35) and the PVR was non-statically different (8.4 vs. 7.2 WU, p=0.63). Post-PTE, CI were normal in both groups (2.4 vs 2.7 L/min, p=0.03). The IDA group had worse baseline NYHA functional class (75% class III or higher, p=0.66) than the non IDA group (90% class II or lower, p=0.66). Those with IDA had lower baseline 6MWD of 277 vs 343 meters (p=0.14; Fig 1), despite a similar baseline PVR and CI. Post PTE and after IV iron repletion, 6MWD were similar between the IDA and non IDA group 385 vs 348 meters; p=0.75, respectively. Conclusion: Our results suggest younger and female CTEPH patients may have a higher incidence of IDA. IDA contributes to the functional capacity of patients with precapillary CTEPH. There is a trend towards improvement of the functional impairment in the CTEPH patients when they receive IV iron repletion in the perioperative period of PTE, in groups that have similar baseline CI and PVR, and normal CI in the post-PTE period.
Abstract 9479: Defined Subsets of Sympathetic Neurons Innervate the Heart and Differentially Respond to Cardiac Pathology
Authors: Sachin Sharma
Journal: Circulation (2022)

Introduction: Sympathetic regulatory aspect of cardiac functions is governed by neural circuit originating from postganglionic sympathetic neurons (PGNs) that primarily reside in stellate ganglia. PGNs is comprised of a diversified neuronal population that innervate heart and other tissue beds. Hypothesis: We hypothesize that cardiac innervating stellate ganglionic neurons (SGNs) exhibit diversity and distinction from those innervating other organs. In the settings of cardiac pathology, distribution of cardiac neuronal subtypes is altered, yielding a dominant neuronal subtype. Methods: We utilized method of retrograde axonal transport from heart and paw using adeno-associated virus (AAV-GFP/tdTomato, 1+e12 gc/ml, 10μl) followed by single cell RNA sequencing (scRNAseq) to identify and resolve transcriptomic profiles of SGNs in normal (n=8) and heart-failure mice (n=4). Using NPY-hrGFP mice, we characterized membrane excitability for NPY high and NPY low neurons (n=11). We delineated impact of NPY on cardiac sympathoexcitation by injecting AAV5-Flex-taCasp3 in NPY-Cre mice (n=8) and afterwards electrically stimulating right stellate ganglia (RSG). Results: In our scRNAseq study, we identified 3 adrenergic neuronal subtypes (NA1a, NA1b, and NA3) innervate heart. These subtypes differentiated as NPY high (NA1a) and NPY low (NA1b and NA3) subpopulations. NPY high (4.250±0.90) showed higher number of action potentials compared to NPY low (1.818±0.18). Cardiac sympathoexcitation was diminished in NPY-ablated mice compared to controls in response to escalating intensities (1, 5, 10, 15, &amp; 20 Hz). Maximal heart-rate change was detected at 10 Hz (p = 0.0240) for NPY-ablated mice (91.061±12.62 bpm) vs. controls (27.017±11.88). Across mice, ~70% of cardiac neurons are NPY+. In dilated cardiomyopathy mice, NA1b is a predominant subtype, consists of increased expression of Kcnq2 (M-current) and significant enriched pathways neurodegenerative disorders and neurotrophic signaling. Conclusion: These findings provide novel insights into the unique properties of neurons responsible for cardiac sympathetic regulation, with implications for novel strategies to target specific neuronal subtypes for sympathetic blockade in cardiac disease.
Abstract 9749: Anthracicline-Induced Cardiotoxicity in Children. Pharmacogenetics and Clinical Study at a Tertiary Center
Authors: Noelia Moreno Toro, Luciana María Marangoni Iglecias, CARMEN CARRERAS BLESA, Maria del Mar Rodriguez Vazquez del Rey, Emilia Urrutia Maldonado, maria jose ortega Acosta, Juan Francisco Pascual Gázquez, Irene Pelaez Pleguezuelos, Francesca Perin
Journal: Circulation (2022)

Introduction: Children and adolescents treated with anthracyclines are at increased risk of developing cardiomyopathy. Although several guidelines are available, no consensus exists on an optimal strategy scheme for predict or avoid anthracycline-induced cardiotoxicity. Methods: Cardiotoxicity was defined as a reduction in left ventricle ejection fraction &gt;10% from baseline and &lt;53%, and/or global longitudinal strain drop of &gt;15%.The incidence of cardiotoxicity, its relation with cumulative anthracycline doses, clinical significance and reversibility were retrospectively evaluated in a paediatric population (0-18 years) treated with anthracycline at a tertiary hospital (2010-2020). Analysis of 3 genetic polymorphisms related to cardiotoxicity (RARG (rs2229774), SLC28A3(rs7853758) and UGT1A6(rs17863783)) was performed. Results: A total of 84 patients (45 males) were included. The mean age at diagnosis was 10.7± 3.8 years with average cumulative anthracycline dose 195 mg/m2 (60-460mg/m2). Median follow-up was 5 years. Anthracycline-induced cardiotoxicity occurred in 12 (14,2%) of treated patients, 75% were asymptomatic. 5 patients experimented acute cardiotoxicity during treatment. 8 patients were treated with ACE-inhibitors and/or beta-blockers. 11 patients had full function recovery. Cumulative doxorubicin dose was a risk factor of cardiotoxicity, being affected 9/20 treated with &gt;250 mg/m2; 3/51 treated with 100-250m2; while no patient out of 13 receiving &lt;100 mg/m2 had an abnormal echocardiogram (P &lt;0.01). A higher percentage of patients treated with mediastinum radiation and chemotherapy (3/7:42%) presented cardiotoxicity compared to those with chemotherapy only (9/77:9%) (p0.09). Younger age, female sex or the presence of genetic polymorphisms studied were not statistically significant risk factors. Conclusions: Dose-dependent anthracycline risk for developing cardiomyopathy was confirmed. However, previously identified risk factors including female sex, early age at diagnosis and genetic polymorphism were not replicated in this population, possibly due to the small sample size and the relatively short follow-up period. A tailored monitoring strategy based on cardiac risk stratification is needed.